| Organization Name: | NEW JERSEY LASER DENTISTRY |
| NPI Number: | 1033395934 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARRY LAURENCE JACOBSON (OWNER) |
| Mailing Address: | 751 Teaneck Rd C/0 Dr Jacobson 3rd Floor Teaneck |
| State: | NJ US |
| Postal Code: | 076664242 |
| Phone Number: | 2018371612 |
| Fax Number: | 2018378651 |
| NPI Enumeration Date: | 01/10/2008 |
| NPI Last Update Date: | 01/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DI19069 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |